David & the dum-dum cancer: Learning More

Today David met with the senior Hematologist, Dr. Brandwein. This guy really knows his stuff and took the time to explain the why, the what next and the how. So now we can share that with you.

Also David was not admitted today, we are waiting for a bed. David is responding well to the hydroxyurea which is keeping his blast numbers stable (not increasing) relative to his overall blood counts.

The Why

There is no explanation beyond bad luck. Acute Myeloid Leukemia does not come from lifestyle choices or family history, generally. And for David those aren't factors. Just the cards he is dealt in this life. They do treat for cure and being young and healthy makes that more likely.

Up Next

David will start induction chemotherapy. The purpose of this chemo is to put David into remission. It will be intense and happens as an in-patient on the hematology floor of the U of A hospital. Basically for the first 3 days he's on 2 chemo drugs and then for 4 more he continues one of them (a 7+3 protocol if you want to know). So he is only getting the drugs for 1 week and the next 3 weeks he recovers in the hospital because those drugs really take out his system - bone marrow, white blood cells, red blood cells and a lot of other things (i.e. hair). They want to monitor him closely in case of infection (did you know your own body can infect you? like your mouth or bowels) since he will have no way to fight. They will also give him blood product transfusions since his body won't be able to make it's own (and was doing a terrible job previously...hence the cancer). He will be in the hospital for about 4 weeks (possibly ending the first week of September)

To make sure he's up for it, he will also get a physical to ensure his heart is strong enough and a central line put in.

The good news: 80% of patients go into remission!! (if he doesn't, he does induction chemo again). This is confirmed by a bone marrow biopsy

During the induction chemo, they will also finish the genetic sequencing of his cancer. The genetic sequence will help them understand how likely he is to relapse (in this world, they only know you're cured if you don't get the cancer again - they just try to keep you in remission for as long as possible, so knowing how likely relapse will occur is very helpful).

They will also reach out to David's brothers (and others) during this time to be tested in the event David needs a stem cell transplant.

Once David is in remission, he will have a few weeks to recover out of the hospital and then will start consolidation chemotherapy (possibly mid to late September). This is done to keep his body in remission. It is less intense and can be done as an out-patient. It still sucks though. We'll learn more about this after we get through induction chemotherapy.

If the genetic testing shows that he is likely to relapse, they will also get ready for a stem cell transplant. Also if the consolidation chemotherapy doesn't keep him in remission, then he might also end up with a stem cell transplant. He might do up to 3 rounds of consolidation chemotherapy. Again all things we'll learn more about as we go.

If he doesn't need a stem cell transplant, then this process will take about 6 months. If he does, then about 1 year.

Here is a handy chart they gave us to explain the process.

Some things I'm thinking about:

• We are getting ready for David to be admitted. We bought some things Reddit told us are handy and I organized it in a cute little caddy for him.

• Once David is doing out-patient chemotherapy the logistics will be a lot trickier because David will need to go to his appointments and be supported during the day. I will see if our family and friends can help with this so that I can keep working and supporting the kids.
• David is a really good husband. Even though the last 7 days have been hard, I've enjoyed spending these days 1:1 with him. We've eaten at our favourite places (Rge Rd and Next Act) and walked around outside. He is funny, thoughtful and very, very kind.
• Ellie returns from Korea on Friday and so I'm working on getting into the headspace to hear about her amazing adventure and appropriately share this change in our family

If you want to pray for David, specifically, here are some things:

• The genetic testing shows that David is *not* likely to relapse
• That the side effects of chemo are as mild as can be
• That infections are detected early and managed effectively
• That Ellie arrives home safely and transitions well into our new reality
• That folks who are prompted to help us, listen and act in whatever way

We know David (and our family) is in the had of the Lord and have felt the strength of prayers, good vibes, and positive thoughts. Please feel free to share David's story with others.

Much love

xoxo